Skills of a mental health nurse

Mental Health Insight

Exercise 1

Mental wellbeing is the ability for one to have a stable mentality about life, someone who goes about day-to-day activities with an open mind. According to MIND, a good mental wellbeing is about an individual is able to do concerning valuing and accepting oneself. This mental wellbeing can be achieved by caring for or about oneself, recognising yourself to be a valuable individual in your own right, not having to earn the right to exist and you tend to judge yourself on realistic standards.

Health Challenge Wales website also illustrated mental wellbeing as; everyone has emotional and mental health needs. Sustaining good mental health is significant because it affects how we reflect and feel about ourselves as well as others. It can also affect how we deal with everyday life events, such as relationships and dealing with change.

Signs of people experiencing mental health problems may vary widely, however people suffering from early stages of mental health illness may not notice changes that are occurring but these changes may be obvious to others. Some common signs may be changes in the way they feel, lack of sleep, not feeling hungry, not caring about their appearance, lethargic, low energy levels, equally feeling highly energetic, wanting to go out a lot, becoming a lot more creative and sociable may signs of high. Hearing voices is one of the main signs and this can be very distressing for a first timer. Some people can start to see images no one else sees and this may cause immense distress.

Biological are those which are biological in nature. They can include our individual genetic make-up and the way that this might put us at more or less risk than others. It has also been found that those who have suffered (usually more severe) head injuries can also experience changes to their personality, and in some cases may begin to experience schizophrenia and psychotic type symptoms. The misuse of substances or illness of mothers during pregnancy, (such as through picking up viruses like the flu) can also lead to changes in their baby’s development which may ultimately effect their mental health. Recent reports have also suggested that vitamin and mineral deficiencies such as Vitamin D, zinc and certain fatty acids may also be related to our mental health and the development of neurological symptoms.

Social factors are those factors around us such as where we live, whether we have strong support networks, (close family and friends who make us feel safe and who we can rely on) our place of work and how and where we can relax. Physical environments such as the neighbourhood where you live can be very stressful, particularly when there are problems with neighbours, or where there are high crime rates and other such issues. Whetheryou enjoyyour work, or feelyou are under too much pressure, are unable to find employment or hold down a job, can all put pressure onyour mental well-being. These kinds of problems will increase the amount of stress people are under, and can cause depression and anxiety, especially in situations where individuals are unable to make changes to alleviate the stressors. When we face difficult times our support networks become very important those who do not have close friends or families, or those who do not live near the people who support them may find it increasingly difficult to cope alone.

Psychological factorscan influence your mental and emotional state, particularly if you arecoping with traumatic and abusive past or current experiences. Significant life events, like bereavement, divorce or if you have self-destructive thought patterns and perceptions, can impact on your mental health. For example, post-traumatic stress disorder (PTSD), anxiety and in more extreme cases Dissociative Identity Disorder (DID – in the past referred to as multiple personality disorder) are all mental health conditions that are commonly found in people who have been abused.

Exercise 2

Integrated care pathways (ICP) are multidisciplinary outlines of expected care, to be used by health professionals to assist service users with particular conditions to move step by step through clinical experiences to attain constructive outcomes. ICPs are important and help to minimise unnecessary variations in patient care and outcomes, however there are circumstances where these variations from pathways are necessary to attain a positive clinical outcome. The importance of ICPs is that they also improve the communication and collaboration between multidisciplinary teams; it also empowers and informs patients and carers to meet the clinical requirements (Middleton S et al, 2001). ICP also encourages local services to assess their own practice and then use that evidence to decide whether the right skills are available to meet the service users’ needs.

The NHS QIS illustrates some of variations of the integrated care pathways of mental health illnesses such as dementia etc. It iterates the planning of patients care using a patient centred approach, in that the care provided must be planned with the patient and their informal carers. It also looks into the patient being allowed to make informed decisions on the treatment and care they receive. Some of the interventions to take place include;

• A generic but comprehensive assessment which looks to identify physical and mental health, social housing and other needs.
• Measures of needs are also part of the ICP which aids the service user and the carers to identify how well services will tackle those needs.
• A generic care plan that involves all the care environments and identifies care needs. The ICP guides the professional undertaking the care plan to take into account past experience, cause of the current state, if present previously what was done to reduce the symptoms at the time.
• The diagnosis of dementia can be made using the ICP records that a diagnosis of dementia (and subtype) is made following a full assessment including history taking (including from third party), cognitive assessment, mental condition examination and general physical examination and investigations as recommended by SIGN 86 guidelines.
• Information about dementia should be made available to the client. The ICP records that, depending on the person’s level of capacity, information is given to the service users and/or carers, about benefits, future management of finances and personal welfare. The ICP records that information is provided about benefits and concessions personal welfare powers of attorney, and sources of independent legal and financial advice.
• It also looks into the vulnerability of people with dementia, that is recording the risk of abuse and neglect to patients are assessed.

With all these assessments undertaken and it becomes apparent that client suffers may show signs of dementia, a referral needs to be made again by the assessor as per the ICP referral guidelines to the community mental health team for a specialist assessment and diagnosis.

Exercise 3

One of the most important skills a nurse can possess is the ability to establish a relationship. Within mental health setting this ability has been described to be crucial as it is the factor that determines the success of interventions of service users who need psychiatric care. Within mental health nurse-patient relationship requires trust (Videbeck S, 2010).

On my first placement in an inpatient ward, I was not sure what to say and when to see anything. A client then approached me and asked my name and how long I was there for. My immediate reaction was one of sock and again relaxation. I answered the questions he put to me and that from the knowledge I have gather was the beginning of a relationship.

Peplau’s model of nursing also illustrates the use of self to promote an effective and therapeutic care delivery. Elder et al defines self as the concept that describes the core of our personality. He also illustrates that the nurses describe congruency, realness and accuracy as a means of projecting the nurse’s true self. Being self aware allows us to be know how to respond to specific situations and knowing our values, attitudes and biases towards people and situations and about knowing how our human needs reflect in our work.

Self-disclosure is used by mental health nurses to again develop therapeutic relationship with clients. In this nurses tend to use their own experience of life to help clients to make sense and appreciate the difficulties of life, this is sometimes immediately or spontaneously noticed by the clients themselves.

From the experience above my self awareness with not knowing what to say initially was noticed by the client to enable him come up to me to engage in that conversation. Through the contact with the client a relationship was created where we ended up disclosing circumstances within our lives with each other, I however was aware of how much of my own information I had to pass on to him.

For an effective and therapeutic use of self a nurse must be aware of the boundaries round ones own values, beliefs and perception of life as a whole. Once these are addressed then one can easily and effectively use self to the benefit of the client-nurse relationship.

Exercise 4

Registered nurse mental health (RNMH) is a nurse who helps psychiatrics, psychologist and other mental health professionals counsel and treat clients with mental disorders. They work within either hospital or community settings. They assist in crisis interventions, help patients with daily care routines, administer medications, and formulate treatment plans and treatment regimens. Psychiatric nurses with master’s degrees who complete practice in a supervised clinical situation can become a mental health nurse practitioner. A nursing student should master the therapeutic alliance, which involves the relationship between a mental health nurse, a psychiatric patient and other health care professionals treating the patient. This can be achieved through elective courses, internships and assisting other professionals with patients in a clinical setting. Psychiatric nurses must earn an RN (registered nurse) designation through proper education and certification before practicing professionally.

Registered nurse adult (RN) is also nurses who

Reference

Videbeck, S. L. 2010, Psychiatric-mental health nursing. 3^rd ed, Philadelphia, Lippincott Williams and Wilkins.

http://www.mhguidelines-leics.nhs.uk/default.aspx?page=oad_guidelines

http://www.nhshealthquality.org/nhsqis/files/MENTALHEALTHICP_STAND_APR07.pdf

http://www.sehd.scot.nhs.uk/publications/DC20090930dementia.pdf